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Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).

Below are some recommended measures to use, as appropriate, to track your progress. In selecting your measures, consider the following:

  • Whenever possible, use measures you are already collecting for other programs.
  • Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.
  • Try to include both process and outcome measures in your measurement scheme.
  • You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.
  • Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2012).

For more information on measuring for improvement contact the Canadian Patient Safety Institute Central Measurement Team at measurement@cpsi-icsp.ca

Outcome Measures

  1. Per cent of patients with air embolism following infusion, transfusion and/or therapeutic injection.
  2. Per cent of patients with phlebitis secondary to intravenous catheterization.
  3. Per cent of patients receiving a blood transfusion who have an ABO incompatibility reaction.
  4. Per cent of pregnant women who have an Rh incompatibility reaction.
  5. Per cent of newborns who have an Rh incompatibility reaction.
  6. Percentage of patients receiving a blood transfusion who have an Rh incompatibility due to a mismatched blood.
  7. Per cent of patients receiving a blood transfusion who have anaphylaxis due to serum.
  8. Per cent of patients receiving a blood transfusion who develop urticaria due to serum.

Process Improvement Measures

Prevention of air embolism following infusion, transfusion and/or therapeutic injection

  1. Per cent of patients who receive the following steps for appropriate care related to infusion, transfusions and/or injections:
    • Remove all air from syringes and intravenous lines.
    • Insert and remove catheters using a technique that minimizes the possibility of air entry to the blood vessels.
    • Arterial and venous catheters and connections are intact and secure.
    • Self-sealing valves of arterial and venous catheters are functioning properly.
    • Use of infusion pumps with air-in-line sensors for all continuous infusions.
    • Remove air from infusion bags when infusing fluids.
    • Trace lines, double-check all connections, and take all steps necessary to prevent tubing disconnections.
    • Inspect on a regularly basis the insertion site, catheter, and all connections to assess for breaks or openings through which air could enter the system.
  2. Percentage of patients with a central line who have the integrity of the central line dressing at the skin insertion site assessed.

Prevention of air embolism secondary to insertion of central venous access device

  1. Percent of patients who receive the following steps involved in appropriate care related to insertion of central venous access device:
    • The patient is placed in the Trendelenburg position with a downward tilt of 10 to 30 degrees during central line placement.
    • Insertion while the patient is holding his or her breath.
    • Hydrate the patient to correct hypovolemia prior to insertion whenever possible.
    • Ensure all catheters and connections are intact and secure.
    • Occlude the catheter and/or needle hub.
    • Ensure that all self-sealing valves are functioning properly.

Prevention of phlebitis secondary to intravenous catheterization

  1. Per cent of patients who receive the following steps involved in the prevention of phlebitis:
    • Appropriate site selection.
    • Appropriate hand hygiene before catheter insertion or maintenance.
    • Proper aseptic technique during catheter manipulation.
    • Use of in-line filters to reduce the incidence of infusion-related phlebitis.

Prevention of ABO incompatibility reaction

  1. Per cent of patients who receive the following steps involved in the prevention of ABO incompatibility reaction:
    • Strict attention to patient identification and tube labelling at sample collection.
    • Verify the patient's identity and date of birth (DOB) by checking their identification band before transfusing.
    • Have the patient state their name and date of birth (DOB), if conscious.

Prevention of Rh incompatibility reaction with pregnant women

  1. Per cent of pregnant women who receive the following steps involved in the prevention of Rh incompatibility reaction:
    • Screen for Rh status.
    • If the mother is Rh-negative, screen the father of the infant. If the father is Rh-positive, or if his blood type is not known, the Rh-negative mother is given an injection of Rh Immune Globulin during the second trimester.
    • If the baby is Rh-positive, the mother is given a second injection of Rh Immune Globulin within a few days of delivery.

Prevention of Rh incompatibility due to a mismatched blood transfusion

  1. Per cent of patients who receive the following steps involved in the prevention of Rh incompatibility due to a mismatched blood transfusion:
    • Strict attention to patient identification and tube labelling at sample collection.
    • Verify the patient's identity and date of birth (DOB) by checking their identification band before transfusing.
    • Have the patient state their name and date of birth (DOB), if conscious.

To prevent anaphylactic shock due to serum: prevention of recurrent anaphylaxis

  1. Per cent of patients who receive the following steps involved in the prevention of recurrent anaphylaxis:
    1. Pre-medicate with intravenous steroids and diphenhydramine.
    2. If a patient is found to be IgA-deficient with anti-IgA, the following products are considered:
      • IgA-deficient blood products from IgA deficient blood donors, available from Canadian Blood Services.
      • Washed RBCs (2L normal saline in 6 wash cycles) or platelets.

Minor allergic reaction: prevention of recurrent urticaria

  1. Per cent of patients who receive the following steps involved in the prevention of recurrent urticarial:
    • Pre-medicate with diphenhydramine, or other non-drowsy antihistamine and/or corticosteroids.
    • Consider using plasma depletion of RBCs or platelets.
    • Consider using washed RBCs or platelets.